Preoperative Measurement of ACL Insertion Sites

Abstract

This study was designed to evaluate preoperative predictions of the femoral and tibial ACL insertion lengths. Intraoperative measurements were made of the femoral and tibial ACL insertion lengths with an arthroscopic ruler. A musculoskeletal radiologist and a sports medicine orthopedic surgeon measured the ACL insertions from preoperative magnetic resonance imagings (MRIs) in a blinded fashion. Correlations between height, weight, body mass index, and gender with intraoperative ACL insertion length measures were also evaluated. Patient height and male gender demonstrated strong correlations with intraoperative ACL insertion measures. A moderate correlation was seen between patient weight and intraoperative ACL insertion measures. When evaluating the frequency with which the raters' respective MRI measures were exactly the same as the intraoperative measures, moderate correlations were seen. The radiologist and orthopedic surgeons' MRI measures were within 3 mm of the intraoperative measures 98 and 75% of the time, respectively, for the femur and 92 and 83% of the time, respectively, for the tibia. This study concludes that preoperative MRI measures of ACL insertion lengths can be used to predict intraoperative ACL insertion lengths. Also, it is expected that taller patients and male patients should have greater ACL insertion lengths seen arthroscopically.

Keywords

ACL insertions - double-bundle ACL reconstruction - anatomic ACL reconstruction

• References

• 1 Mochizuki T, Muneta T, Nagase T, Shirasawa S, Akita KI, Sekiya I. Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction. Arthroscopy 2006; 22 (4) 356-361
• 2 Ferretti M, Ekdahl M, Shen W, Fu FH. Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 2007; 23 (11) 1218-1225
• 3 Heming JF, Rand J, Steiner ME. Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 2007; 35 (10) 1708-1715
• 4 Hwang MD, Piefer JW, Lubowitz JH. Anterior cruciate ligament tibial footprint anatomy: systematic review of the 21st century literature. Arthroscopy 2012; 28 (5) 728-734
• 5 Iwahashi T, Shino K, Nakata K , et al. Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography. Arthroscopy 2010; 26 (9, Suppl): S13-S20
• 6 Kopf S, Pombo MW, Szczodry M, Irrgang JJ, Fu FH. Size variability of the human anterior cruciate ligament insertion sites. Am J Sports Med 2011; 39 (1) 108-113
• 7 Colombet P, Robinson J, Christel P , et al. Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 2006; 22 (9) 984-992
• 8 Purnell ML, Larson AI, Clancy W. Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography. Am J Sports Med 2008; 36 (11) 2083-2090
• 9 Siebold R, Ellert T, Metz S, Metz J. Femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry and arthroscopic orientation models for double-bundle bone tunnel placement—a cadaver study. Arthroscopy 2008; 24 (5) 585-592
• 10 Siebold R, Ellert T, Metz S, Metz J. Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy 2008; 24 (2) 154-161
• 11 Takahashi M, Doi M, Abe M, Suzuki D, Nagano A. Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med 2006; 34 (5) 787-792
• 12 Wu E, Chen M, Cooperman D, Victoroff B, Goodfellow D, Farrow LD. No correlation of height or gender with anterior cruciate ligament footprint size. J Knee Surg 2011; 24 (1) 39-43
• 13 Bedi A, Musahl V, O'Loughlin P , et al. A comparison of the effect of central anatomical single-bundle anterior cruciate ligament reconstruction and double-bundle anterior cruciate ligament reconstruction on pivot-shift kinematics. Am J Sports Med 2010; 38 (9) 1788-1794
• 14 Gadikota HR, Seon JK, Chen CH, Wu JL, Gill TJ, Li G. In vitro and intraoperative laxities after single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 2011; 27 (6) 849-860
• 15 Kondo E, Merican AM, Yasuda K, Amis AA. Biomechanical comparison of anatomic double-bundle, anatomic single-bundle, and nonanatomic single-bundle anterior cruciate ligament reconstructions. Am J Sports Med 2011; 39 (2) 279-288
• 16 Musahl V, Voos JE, O'Loughlin PF , et al. Comparing stability of different single- and double-bundle anterior cruciate ligament reconstruction techniques: a cadaveric study using navigation. Arthroscopy 2010; 26 (9, Suppl): S41-S48
• 17 Aglietti P, Giron F, Losco M, Cuomo P, Ciardullo A, Mondanelli N. Comparison between single-and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med 2010; 38 (1) 25-34
• 18 Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH. Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Am J Sports Med 2012; 40 (3) 512-520
• 19 Izawa T, Okazaki K, Tashiro Y , et al. Comparison of rotatory stability after anterior cruciate ligament reconstruction between single-bundle and double-bundle techniques. Am J Sports Med 2011; 39 (7) 1470-1477
• 20 Meredick RB, Vance KJ, Appleby D, Lubowitz JH. Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Am J Sports Med 2008; 36 (7) 1414-1421
• 21 Park SJ, Jung YB, Jung HJ , et al. Outcome of arthroscopic single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a preliminary 2-year prospective study. Arthroscopy 2010; 26 (5) 630-636
• 22 Suomalainen P, Järvelä T, Paakkala A, Kannus P, Järvinen M. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 5-year results. Am J Sports Med 2012; 40 (7) 1511-1518